DISTINCTIVE EYEWEAR (NPI# 1558443168) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558443168 |
| Entity Type | Organization |
| Organization Name | DISTINCTIVE EYEWEAR |
| Other Organization Name | NORTHWEST EYEWEAR |
| Practice Address |
21395 John Milless Dr Suite 200 Rogers MN 55374-4402 |
| Practice Telephone | 7634167600 |
| Mailing Telephone | 7634167600 |
| Mailing Fax Number | 7634167670 |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2011-08-01 |
| Authorized Official Name | AUDREY IRENE BERG (BUSINESS OFFICE SUPERVISOR) |
| Authorized Official Telephone | 7633834140 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 156FX1800X |
Technician/Technologist Specialization: Optician |
Eye and Vision Services Providers | ||
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Northwest Eyewear | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073750071 | Distinctive Eyewear | Technician/Technologist | 18157 Carson Ct Nw, Suite C, Elk River, MN 55330-3610 | 2009-01-13 |
| 1215019823 | Distinctive Eyewear | Technician/Technologist | 2805 Campus Dr, Suite 105, Plymouth, MN 55441-2676 | 2006-10-20 |
| 1033291612 | Distinctive Eyewear | Technician/Technologist | 5657 Duluth St, Golden Valley, MN 55422-4054 | 2006-10-20 |
| Street Address |
21395 JOHN MILLESS DR SUITE 200 |
| City | ROGERS |
| State | MN |
| Zip Code | 55374-4402 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609872522 | Novacare Outpatient Rehabilitation East Inc | Clinic/Center | 21395 John Milless Dr, Rogers, MN 55374-4402 | 2005-06-24 |
| 1083075865 | Katelyn O'keefe | Occupational Therapist | 21395 John Milless Dr, Suite 600, Rogers, MN 55374 | 2016-03-08 |
| 1497124929 | Ariel Schibilla | Family Medicine | 21395 John Milless Dr, Rogers, MN 55374-4402 | 2015-09-15 |
| 1184069304 | Kristina Kay Thissen | Physician Assistant | 21395 John Milless Dr, Rogers, MN 55374-4402 | 2013-05-01 |
| 1891934188 | Jeffrey Kent Sletten | Physical Therapist | 21395 John Milless Dr, Suite 600, Rogers, MN 55374-4402 | 2009-02-11 |
| 1073699823 | Northwest Eye Clinic, P.a. | Ophthalmology | 21395 John Milless Dr, Rogers, MN 55374-4402 | 2006-10-27 |
| 1598712820 | Chandra Shirley | Physical Therapist | 21395 John Milless Dr, Suite 600, Rogers, MN 55374-4402 | 2006-05-30 |
| 1447229786 | David Allen Everson | Physical Therapist | 21395 John Milless Dr, Rogers, MN 55374-4402 | 2006-03-17 |
| 1912975954 | Ann M Murphy | Physical Therapist | 21395 John Milless Dr, Suite 600, Rogers, MN 55374-4402 | 2006-03-08 |
| 1205802576 | Luann K Lerud | Physical Therapist | 21395 John Milless Dr, Rogers, MN 55374-4406 | 2006-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609335835 | Rebecca Loehrer | Nurse Practitioner | 21370 Ste 210 John Milless Dr., Rogers, MN 55374 | 2019-03-18 |
| 1255722328 | Samantha Colai | Marriage & Family Therapist | 21307 John Milless Drive, Suite 106, Rogers, MN 55374 | 2015-02-11 |
| 1437559648 | Jamie Mosley | Counselor | 2100 Rogers Drive, Suite 200, Rogers, MN 55374 | 2014-08-26 |
| 1295145886 | Marisa Kolasa | Massage Therapist | 22290 Oakdale Drive, Rogers, MN 55374 | 2014-05-05 |
| 1871878165 | Derek P Doty Dc Inc | Chiropractor | 21410 136th Ave N, Suite 105a, Rogers, MN 55374 | 2011-10-18 |
| 1912205865 | Michelle Cheryl Finnegan-larson | Registered Nurse | 21308 John Milless Drive, Rogers, MN 55374 | 2011-03-02 |
| 1639402571 | Ascend Family Institute | Community/Behavioral Health | 20980 Rogers Drive, #400, Rogers, MN 55374 | 2009-09-10 |
| 1275738403 | Nicole M Clements | Physician Assistant | 1355 Rogers Drive, Rogers, MN 55374 | 2007-06-18 |
| 1558566166 | Grand St Paul Cvs LLC | Durable Medical Equipment & Medical Supplies | 21455 John Milless Drive, Rogers, MN 55374 | 2007-06-15 |
| 1811062854 | Randall Alvin Hohbein | Pharmacist | 21351 John Milless Drive, Rogers Drug, Rogers, MN 55374 | 2006-11-22 |
| Find all providers in zip 55374 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396219374 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 2600 W Pleasant Crossing Dr Ste 60, Rogers, AR 72758-8323 | 2019-01-14 |
| 1538210364 | Luxottica Retail North America Inc | Eyewear Supplier (Equipment, not the service) | 21615 S Diamond Lake Rd, Rogers, MN 55374-8893 | 2007-01-16 |
| 1659454122 | Walmart Inc. | Eyewear Supplier (Equipment, not the service) | 2110 W Walnut St, Rogers, AR 72756-3246 | 2006-10-20 |
| 1558320325 | Eye Associates Leasing Company Inc. | Eyewear Supplier (Equipment, not the service) | 3737 W Walnut St, Rogers, AR 72756-1839 | 2006-03-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801493903 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 11995 Business Park Blvd N, Champlin, MN 55316 | 2020-10-02 |
| 1659920460 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 3408 Galleria, Edina, MN 55435 | 2019-09-05 |
| 1891351268 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1101 E College Dr, Marshall, MN 56258-2366 | 2019-05-11 |
| 1730745100 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1459 W Service Dr, Winona, MN 55987-2512 | 2019-05-11 |
| 1649836016 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1023 E Blue Earth Ave, Fairmont, MN 56031-4076 | 2019-05-11 |
| 1124684592 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1004 18th Ave Nw Ste D, Austin, MN 55912-1993 | 2019-05-11 |
| 1053977421 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 1620 Broadway Ave S Ste 4, Rochester, MN 55904-7927 | 2019-05-11 |
| 1942866371 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 4051 W Division St Ste A, Saint Cloud, MN 56301-3741 | 2019-05-10 |
| 1831651165 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 3366 Oakdale Ave N Ste 140, Robbinsdale, MN 55422-2961 | 2019-04-04 |
| 1538624341 | Don Sealock, O.d., P.a. | Eyewear Supplier (Equipment, not the service) | 9825 Hospital Dr # 106, Maple Grove, MN 55369-4479 | 2019-02-06 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.